Provider Demographics
NPI:1790950152
Name:TEDDERS, PIERRE J (DDS)
Entity Type:Individual
Prefix:
First Name:PIERRE
Middle Name:J
Last Name:TEDDERS
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:113 W FRONT ST
Mailing Address - Street 2:
Mailing Address - City:ADRIAN
Mailing Address - State:MI
Mailing Address - Zip Code:49221-2072
Mailing Address - Country:US
Mailing Address - Phone:517-263-3400
Mailing Address - Fax:517-263-4027
Practice Address - Street 1:113 W FRONT ST
Practice Address - Street 2:
Practice Address - City:ADRIAN
Practice Address - State:MI
Practice Address - Zip Code:49221-2072
Practice Address - Country:US
Practice Address - Phone:517-263-3400
Practice Address - Fax:517-263-4027
Is Sole Proprietor?:No
Enumeration Date:2008-04-28
Last Update Date:2008-04-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI29010176441223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice